The purpose of the conference was to share new developments in the use of TMS, as well as in how TMS providers are communicating with patients before, during, and after TMS treatments. Neurogenics asked a number of experts in medical communications to speak. And, it was Neurogenics that offered all of us using TMS the title “pioneers” in this exciting new treatment for depression.

Most valuable to me was the chance to network with TMS providers from across the USA. We were able to exchange ideas about success rates with patients and patient selection, among many other thoughts. Most encouraging for me was to hear the incredible success rates being reported. The original FDA-required research data for TMS showed TMS success rates in the area of 50%. However, most of my colleagues across the country are reporting rates closer to 70%!

These of course have to be considered “anecdotal” at this point—that is they are not from carefully controlled double-blind, sham-controlled research studies. Nevertheless, they are quite impressive.

Why would the results in private non-research practices be better that research results? One possible reason that occurs to me is that we (private TMS providers) do not take our TMS patients off of their anti-depressant medications, and/or their psychotherapy, during the weeks they are receiving TMS. By contrast in the FDA data, all TMS patients were required to be off of all medications during TMS treatments.

Is it possible that we are getting even better results by keeping people on anti-depressant medications during TMS? I certainly cannot prove this statement for the moment, but I am hopeful that future research may provide some answers.

—Posted by John C. Shershow, M.D.

One question that all of us have been wondering about at last has some data to ponder: How lasting are the improvements that patients experience with TMS? Two research studies were reported at this year´s meeting of the American Psychiatric Association on the durability of TMS response.

First, it should be noted that the relapse rates with traditional anti-depressant medications are often much higher than we would wish. “Relapse rates” is the medical expression to describe patients who again become depressed after apparently successful treatment, either with medications or with TMS.

Phillip G. Janicak, M.D. of Rush University Medical Center in Chicago reported on 99 patients who achieved a good result on TMS: during a 6-month follow-up, 12% of patients who had initially had a good response to TMS experienced another episode of depression. This compares with approximately 40% who had another episode of depression in the largest and best-known national study of anti-depressant medication (the “STAR*D study”).

Another study with strikingly similar results was reported by Antonio Mantovani, M.D. of Columbia University in New York City. Sixty-one patients who had achieved a good result with TMS showed an 11.5% relapse rate during their 6-month follow-up.

Clearly, our use of TMS is new, and only 18 months have passed since it was approved by the FDA. We still have a lot to learn in predicting which patients will have a significant improvement with TMS. Nevertheless, it seems to me that these results are very encouraging, particularly since they were reported by two separate research centers. Relapse rates of 12% compared to 40% in responder groups are clearly a very, very favorable sign for the effectiveness of TMS. These rates are encouraging for all of us—providers as well as patients—who are involved in TMS.

—Posted by John C. Shershow, M.D.